The impact of QuoCCA education and factors that enhance workforce capability and education outcomes Quality of Care Collaborative Australia (QuoCCA) Penelope Slater and Leigh Donovan 25 May 2020 7 th Rural and Remote Health Scientific Symposium
Authors : Dr Penelope Slater, Dr Leigh Donovan, Dr Anthony Herbert, Sarah Baggio, Alison McLarty, Julie Duffield, Lee-anne Pedersen, Dr Jacqueline Duc, Angela Delaney, Susan Johnson, Melissa Heywood, Charlotte Burr, Quality of Care Collaborative Australia . Acknowledgements : This project involved a collaboration of six tertiary paediatric palliative care entities throughout Australia managed through the National Project Lead Entity, Children’s Health Queensland (CHQ) Hospital and Health Service. The collaboration included staff from tertiary paediatric palliative care services from Queensland Children’s Hospital, Brisbane; Sydney Children’s Hospital, Randwick; John Hunter Children’s Hospital, Newcastle; Royal Children’s Hospital, Melbourne; Women’s and Children’s Health Network, Adelaide; and Perth Children’s Hospital, Perth. Appreciation goes to the collaboration members and their supporting agencies, including the other QuoCCA Project Leads from each state - Sara Fleming, South Australia; Jenny Hynson, Victoria; Marianne Phillips and Suzanne Momber, Western Australia; and Sharon Ryan and Susan Trethewie, New South Wales. Many thanks also to the educators and participants in the QuoCCA education, from both the private and public sector, and those that provided their helpful assistance in undertaking interviews.
What is QuoCCA? • QuoCCA – Quality of Care Collaborative Australia • Providing paediatric palliative care (PPC) education and mentoring for health professionals in all states of Australia since 2015 • Funded through Australian Govt Dept of Health, National Palliative Care Projects
QuoCCA collaboration • Collaboration of six tertiary PPC services (Qld, NSW x2, Vic, SA, WA) • Funded for 5 Nurse Educators, a National Allied Health Educator, and 3 Medical Fellow positions • Supported through national project staff in Children’s Health Queensland
Aims of QuoCCA • To enhance the knowledge, skills and confidence of acute and community based health professionals in the principles of paediatric palliative care • Participants engaged in either: – A scheduled general education session – ‘Pop up’ education and mentoring focused on the support of a specific patient in their local area – Incidental education through QuoCCA presence at meetings, handovers, grand rounds etc
QuoCCA evaluation study Study aims • To evaluate the impact of QuoCCA education from the perspective of educators and participants • To identify factors that enhance workforce capability and education outcomes in PPC • To translate findings and build capacity in the rural and remote workforce
Methods • Impact surveys completed before and after the education sessions with responses related to a 5 point Likert scale of knowledge and confidence across 9 domains related to the care of the child and family (Slater et al, 2018): • Managing a new referral • Symptom management – pain, nausea, dyspnoea, seizures, fear/anxiety • Giving medication, including subcutaneous • Preparing the family • Using local agencies and resources
Methods • The 9 measures were analysed against 8 independent variables which were education and participant related. • Education - Education type, length of education session, state, remoteness, financial year • Participant - Previous experience caring for a child with a life limiting condition, previous education in PPC, occupation
Methods Outcome surveys were completed more than 6 months following the QuoCCA education session and assessed: • The value of different aspects of the education curriculum • Changes in practice or care of patients and families as a result of participation in QuoCCA education
Methods • Discovery Interviews with 16 Educators and Health Professionals who had provided or received education (Slater & Philpot, 2016; Donovan et al, 2019) • Discovery Interview spine – Meeting the family – Caring for the child and family – End of life care of the child – Ongoing support for the family – Providing future paediatric palliative care – QuoCCA education
Data analysis Quantitative analysis Statistics performed on the survey results, included: • Wilcoxon signed ranks test on the scores pre and post education • Binomial logistic regression to determine the factors that predict change in scores following education Qualitative analysis Thematic analysis of interview transcripts
Results
QuoCCA 1 outputs 2015-2017 • 337 education sessions, 767 hours, 5773 attendees • 808 doctors, 3280 nurses, 562 allied health professionals, 617 others (teachers, funeral directors, pastoral carers etc) and 506 of unrecorded occupation • Education provided in every state and territory in Australia, with 203 provided in major cities, 117 in regional areas, and 16 in remote areas • Paired pre and post surveys completed by 969 participants
QuoCCA 1 education impact Average confidence for paired pre and post education surveys (n=969) Pre surveys Post surveys Average increase in confidence for 4.0 paired pre vs post surveys (n=969) 3.5 1.20 3.0 2.5 1.00 2.0 0.80 1.5 1.0 0.60 0.5 0.40 0.0 0.20 0.00
QuoCCA 1 pre and post surveys Number of participants who declined, stayed the same or improved in their post education score Measure Decline in score Same score Improved score % improved Post < Pre Post = Pre Post > Pre Referral 17 200 693 76.2 Pain 33 328 503 58.2 Nausea 45 356 448 52.8 Dyspnoea 32 313 496 59.0 Seizures 35 369 433 51.7 Fear 24 293 558 63.8 Resources 20 209 685 74.9 Preparation 17 208 692 75.5 Medication 48 374 346 45.1
Education impact • Participants showed a significant increase in knowledge and confidence for all measures following education (Wilcoxon signed ranks P<0.001)
Predicting an increase in knowledge/confidence • Participants with previous experience caring for a child with a life limiting condition had significantly higher scores before and after education. Those with no previous experience were more likely to improve in confidence and knowledge. • Those with previous PPC education had significantly higher scores before and after education. Those with no previous education were more likely to improve in confidence and knowledge. • Participants in longer education sessions were more likely to improve in confidence and knowledge. • Regional and remote participants were more likely to improve than city participants in confidence in the management of nausea and seizures and knowledge of resources that can assist in providing care.
Participant survey comments • “I feel more confidence with assisting families in caring for their palliative child, conversing with them, showing empathy/compassion and guiding them to services available.” HP1099, 2017 . • “Though I was unaware about PPC, after attending today’s class, I feel I am filled with vast information about PPC and confident enough to deliver care to a terminally ill child and also to support the child’s family.” HP1052, 2016 .
Educator learnings • More effective education had the following characteristics: • Tailored to the needs of the audience • Interactive • Included story-telling, case studies and parent experiences
Outcome survey • Outcome survey completed more than 6 months following education • QuoCCA education was rated by 98% of surveyed participants as valuable (33%) or extremely valuable (65%) (n=146) • 78% said it was extremely or very helpful in making a difference to their practice and care of patients (n=114)
Demographics Health Care Professionals n Educators n Occupation Medical – paediatrician 1 Senior nurse 2 6 Allied Health Discovery Dietician 1 Music Therapist 1 Occ Therapist 1 Interviews Physiotherapist 1 1 Social Worker 2 with Health State of origin of interviewee Queensland 6 3 Professionals New South Wales 1 Victoria 1 South Australia 2 2 Western Australia 1 Remoteness area Major city 5 8 Inner regional 1 Outer regional 2 TOTAL 8 8
Interviews with Health Professionals Four themes related to 2. Developing paediatric 1. Building inter- palliative care capability professional education relationships 4. Learning 3. Sustaining from children wellbeing and families
Building capacity • The dedicated QuoCCA educators were instrumental in the development and harmonisation of education across Australia. As educators became more experienced, they used more effective interactive teaching methods, and were flexible to the learning needs and experience of participants. Accessibility of education was improved through local delivery and online resources and education modules. Visits to regional areas also allowed the educators to understand the services and families involved.
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